Provider Demographics
NPI:1063672616
Name:WALLING, NICOLE JORDAN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JORDAN
Last Name:WALLING
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 MEIRWOODS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8454
Mailing Address - Country:US
Mailing Address - Phone:713-819-3275
Mailing Address - Fax:281-379-6041
Practice Address - Street 1:1714 MEIRWOODS DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8454
Practice Address - Country:US
Practice Address - Phone:713-819-3275
Practice Address - Fax:281-379-6041
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist